Plaintiff (Attorney Jeon Soo-hee et al., Counsel for the plaintiff-appellant)

The Health Insurance Review and Assessment Service (Law Firm Gyeong, Attorney Cho Young-chul, Counsel for defendant-appellant)

Gwangju District Court Decision 2004Guhap1926 Decided February 15, 2007

September 1, 2008

1. The plaintiff's appeal is dismissed.

2. The costs of appeal shall be borne by the Plaintiff.

The judgment of the first instance court shall be revoked. The defendant's "date of disposition" in the attached list shall be revoked on the date of each disposition, as stated in the "name of the patient" against the plaintiff on the date of the relevant disposition, "the part on which the revocation is sought" in the reduction disposition against the

1. The issues of the instant case and the judgment of the first instance court

The key issue of the instant case is whether the Plaintiff, as indicated in the separate sheet, performed dyp surgery, spinal equipment dypology surgery, and dypology surgery for each patient listed in the separate sheet, was medically properly treated in light of the general principles of medical care benefits, and the details of the standards and methods for determining and paying medical care benefits costs, which were enacted upon delegation by the National Health Insurance Act and the Enforcement Rule of the National Health Insurance Act and the same Act.

In this regard, the first instance court recognized the discretion to choose the method of treating a patient's disease, but the discretion has the limitation that the most economical and effective method of medical care should be chosen from the internal aspect of the reasonableness of the medical care itself and the external aspect of the promotion of public welfare. According to the Health Insurance Act and its Enforcement Rules, when a medical care institution claims for the examination of a specific medical care benefit to the defendant, the first instance court affirmed the medical burden of proving that the medical care benefit falls under any of the criteria of recognition provided in the detailed rules on the standards of health care benefits for national health insurance or the criteria and methods of the medical care benefits for the application of the medical care benefits for the medical care benefits for the patient of this case, and determined that the medical care benefit amount is not the standard of recognition provided for in the detailed rules on the standards of health care benefits for the patient's health care benefits for each patient of this case, and thus, it does not correspond to the criteria of recognition of spine cry using spine death in spine (1) and the standard of recognition of the medical care benefit amount.

However, such judgment of the first instance court is recognized as correct in full view of the result of pleadings including the addition in the following 2-B.

2. Quotation and additional determination of judgment of the first instance;

A. Therefore, the reasons why the court uses this case are the same as the reasons for the judgment of the court of the first instance, except for adding the judgment on the plaintiff's assertion as follows. Thus, this case is cited in accordance with Article 8 (2) of the Administrative Litigation Act and the main sentence of Article 420 of the Civil Procedure Act.

B. Additional determination

(1) The plaintiff's assertion

The criteria and methods for the application of the medical care benefits for the instant patients are as follows: (a) the criteria for recognition of spine crye using spine crye crye crye, (b) the criteria for recognition of materials for medical treatment, (c) the criteria for recognition of spine crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye crye c.; (d) the criteria for recognition of spine crye crye crye crye crye c.

(2) Determination

In light of the following circumstances recognized by the overall purport of oral argument, there were cases where spinal dyecology and dyecology were conducted in the process of examination by the vertebrate Special Examination Committee and the vertebrate Evaluation Committee. The above committees discussed this issue by the vertebrate Evaluation Committee. The above committees requested and gathered relevant documents, specialized academic societies, pharmaceutical organizations, opinions of experts, etc., so that spinal dyecology and dyecology treatment can be prevented from abnormal dyeculation and maintaining dyecium level at normal level, and thus, it appears that the defendant's determination of medical care benefits in this case was conducted with the advantage of preventing chronic pressure by maintaining the cryecopic dyecium level at the time of oral argument, but it was necessary to establish separate guidelines for examination of spinal dyecology and dyecology in this case, and thus, the defendant did not have any general guidelines for examination of medical care benefits in this case before the plaintiff's argument.

Furthermore, the criteria for recognition of spine crypian using spine crypians are applied to the patients of No. 17 and three others (the patients of No. 18, No. 10, No. 20, No. 11, No. 21, No. 21) among the patients for whom the plaintiff asserts that the above criteria are not applied, and the criteria for recognition of spine crypian using spine crypians are applied. However, the same is the corresponding column of the judgment of the court of first instance cited as above, that all procedures for each of the above patients do not meet the above criteria for recognition.

Therefore, the plaintiff's above assertion is without merit.

3. Conclusion

Therefore, the plaintiff's claim of this case is dismissed as it is without merit, and the judgment of the court of first instance is correct, and it is so decided as per Disposition.

[Attachment]

Judges Donsung (Presiding Judge)